Provider Demographics
NPI:1902802689
Name:DURAND, BLANCA ILEANA (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:ILEANA
Last Name:DURAND
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1240 HIGHWAY 54 W
Mailing Address - Street 2:STE 700
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4565
Mailing Address - Country:US
Mailing Address - Phone:770-474-7416
Mailing Address - Fax:770-389-6210
Practice Address - Street 1:1101 HOSPITAL DR
Practice Address - Street 2:STE 100A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9076
Practice Address - Country:US
Practice Address - Phone:770-474-7416
Practice Address - Fax:770-389-6210
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA046956207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00825382Medicaid
GA04BDCHTMedicare ID - Type Unspecified
GA00825382Medicaid